Can a History of Post-ictal Relief Be a Clinical Aid to Diagnose Functional Seizures?
Abstract number :
1.315
Submission category :
4. Clinical Epilepsy / 4B. Clinical Diagnosis
Year :
2024
Submission ID :
1192
Source :
www.aesnet.org
Presentation date :
12/7/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Ma-an jane Diamos, MD – National Hospital for Neurology and Neurosurgery
Kamiar Shalfrooshan, MD BCh BAO – National Hospital for Neurology and Neurosurgery
Mario Narciso Marcelo, MD MBA – National Hospital for Neurology and Neurosurgery
Mahinda Yogarajah, MD PhD – Department of Clinical and Experimental Epilepsy, Institute of Neurology, Faculty of Brain Sciences, University College London
Fergus Rugg-Gunn, MBBS FRCP PhD – National Hospital for Neurology and Neurosurgery
Meneka Sidhu, MBChB, MRCP, PhD – National Hospital for Neurology and Neurosurgery
Suzanne O'Sullivan, MD – National Hospital for Neurology and Neurosurgery
Rationale: The purpose of this study was to determine the significant association and predictive value of reported post-ictal relief, which has been previously described (Stone et al), with video telemetry electroencephalography (VT-EEG) diagnosed functional seizures.
Methods: Short-term inpatient admissions in the Chalfont Epilepsy Centre, for the purpose of having diagnostic VT-EEG, were used as the population of this study. In a span of a month, 16 patients were identified to be valid cases. The patients excluded were those with severe mental health disorder, those unable to answer the questions asked and patients with a diagnosis of both functional and epileptic seizures. Reports of post-ictal relief were collected verbally and documented during history-taking as part of the regular clinical admission process. Diagnosis of functional seizures or epileptic seizures were determined from the final VT-EEG reports of their admission.
Patient data from electronic records were coded in SPSS. Binary logistic regression was used to determine if post-ictal relief is a statistically significant predictor variable for a functional seizure diagnosis. In this regression, patients diagnosed with epileptic seizures were the reference category.
Results: There were 10 who reported post-ictal relief and 6 who denied this experience. Of the 10 with post-ictal relief, 90% (9 cases) were diagnosed with functional seizures. On the other hand, only 33% (2 cases) of those without post-ictal relief were diagnosed as functional.
Post-ictal relief was found to have a b-coefficient of 2.89 while being statistically significant (p 0.034) with a 95% CI.
Conclusions: In a population of 16 patients, reported post-ictal relief was found to be a statistically significant positive predictive variable of a VT-EEG diagnosis of functional seizures. Therefore, asking about post-ictal relief could be a helpful tool in the history taking process when trying to differentiate between functional and epileptic seizures.
Reference:
Stone, J. and Carson, A.J. (2013) ‘The unbearable lightheadedness of seizing: Wilful submission to dissociative (non-epileptic) seizures’, Journal of Neurology, Neurosurgery & Psychiatry, 84(7), pp. 822–824. doi:10.1136/jnnp-2012-304842.
Funding: Not applicable
Clinical Epilepsy